Association Between Direct Oral Anticoagulant Score and Bleeding Events in Patients With Atrial Fibrillation Following Transcatheter Aortic Valve Replacement: A Retrospective Multicenter Cohort Study.

IF 5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of the American Heart Association Pub Date : 2024-11-07 DOI:10.1161/JAHA.124.036417

Yoshihiro Harano, Masanori Yamamoto, Tetsuro Shimura, Munenori Okubo, Yutaka Koyama, Ryo Yamaguchi, Ai Kagase, Takahiro Tokuda, Fumiaki Yashima, Shinichi Shirai, Norio Tada, Toru Naganuma, Masahiro Yamawaki, Futoshi Yamanaka, Kazuki Mizutani, Masahiko Noguchi, Hiroshi Ueno, Kensuke Takagi, Yohei Ohno, Masaki Izumo, Hidetaka Nishina, Masahiko Asami, Toshiaki Otsuka, Yusuke Watanabe, Kentaro Hayashida

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Abstract

Background: The Direct Oral Anticoagulant (DOAC) Score can predict bleeding risk in patients with atrial fibrillation taking DOACs; however, it lacks external validation. Therefore, this study aimed to assess the association between the DOAC Score and bleeding events in patients with atrial fibrillation who underwent transcatheter aortic valve replacement.

Methods and results: This retrospective multicenter cohort study included patients with atrial fibrillation who underwent transcatheter aortic valve replacement, as registered in a Japanese multicenter registry. The primary end point was the incidence of bleeding. Patients were categorized based on their DOAC Score: low and moderate- (≤7 points), high- (8-9 points), and very high-risk (≥10 points) groups. Among 1230 patients (mean age 84.6±5.1 years; 457 men), 465 (37.8%) received a vitamin K antagonist, and the remaining patients received DOACs. The low and moderate-, high-, and very high-risk groups included 380 (30.1%), 497 (40.4%), and 353 patients (28.7%), respectively. The 3-year cumulative incidence of all bleeding events was significantly different among the 3 groups (low and moderate risk: 6.6%, high risk: 6.9%, and very high risk: 14.0%; P<0.01). Multivariable Cox regression analysis revealed that significant increments in the DOAC Score were associated with a risk of all bleeding events at 3 years in the overall cohort (hazard ratio [HR], 1.22 [95% CI, 1.08-1.38]; P<0.01), in the DOAC cohort (HR, 1.20 [95% CI, 1.01-1.42]; P=0.04), and in the vitamin K antagonist cohort (HR, 1.25 [95% CI, 1.04-1.50]; P=0.02).

Conclusions: The DOAC Score was significantly associated with bleeding events in patients with atrial fibrillation after transcatheter aortic valve replacement, aiding in clinical decision-making for anticoagulant management.

Registration: URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023585; Unique identifier: UMIN000020423.

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经导管主动脉瓣置换术后心房颤动患者的直接口服抗凝剂评分与出血事件之间的关系：一项回顾性多中心队列研究。

背景：直接口服抗凝剂（DOAC）评分可以预测服用DOAC的房颤患者的出血风险；然而，它缺乏外部验证。因此，本研究旨在评估接受经导管主动脉瓣置换术的心房颤动患者的 DOAC 评分与出血事件之间的关联：这项回顾性多中心队列研究纳入了在日本多中心登记处登记的接受经导管主动脉瓣置换术的心房颤动患者。主要终点是出血发生率。根据患者的 DOAC 评分对其进行分类：中低风险组（≤7 分）、高风险组（8-9 分）和极高风险组（≥10 分）。在 1230 名患者（平均年龄为 84.6±5.1 岁；457 名男性）中，465 人（37.8%）接受了维生素 K 拮抗剂治疗，其余患者接受了 DOACs 治疗。低危、中危、高危和极高危组分别有 380 名患者（30.1%）、497 名患者（40.4%）和 353 名患者（28.7%）。所有出血事件的 3 年累积发生率在 3 组之间存在显著差异（中低风险：6.6%，高风险：6.9%，极高风险：14.0%；PPP=0.04），在维生素 K 拮抗剂队列中也存在显著差异（HR，1.25 [95% CI，1.04-1.50]；P=0.02）：DOAC评分与经导管主动脉瓣置换术后心房颤动患者的出血事件显著相关，有助于抗凝管理的临床决策：URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023585; Unique identifier：UMIN000020423。

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来源期刊

Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

1.90%

发文量

1749

审稿时长

12 weeks

期刊介绍： As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.